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ADDRESS BY THE PRESIDENT, MARY ROBINSON, ON THE OCCASION OF THE BARTHOLOMEW MOSSE MEMORIAL LECTURE

ADDRESS BY THE PRESIDENT, MARY ROBINSON, ON THE OCCASION OF THE BARTHOLOMEW MOSSE MEMORIAL LECTURE AT THE ROTUNDA HOSPITAL

I was delighted to accept the Master's invitation to deliver the annual Bartholomew Mosse lecture in this, the Rotunda Hospital's 250th anniversary year. Last Monday night I sat here in the Gate Theatre and enjoyed a performance of "The Picture of Dorian Gray" by Oscar Wilde. It seems fitting that I would begin by borrowing the words of Oscar's father, William Wilde, written just after the first centenary of the Rotunda Hospital, in which he described Bartholomew Mosse as a `great and good man . . .possessing great energy and benevolence of character, which he so employed as to have conferred immeasurable benefit upon his own and subsequent generations.'

In a way I am relieved that I do not need to tell the story either of the man, Bartholomew Mosse, or the Dublin Lying-in Hospital which he founded, because their stories have been well told in a number of publications. The most recent of these, "Masters, Midwives and Ladies in Waiting: The Rotunda Hospital 1745-1995", edited by a former Master, Alan Browne, was commissioned to mark the 250th anniversary. It tells the story of the hospital very much in the context of the development of Irish society over that period, and the changing approaches to medical and social services. I also like the way Ian Campbell Ross speaks of Mosse in his essay included in "Public Virtue, Public Love", a book on the early years of the Rotunda, published in 1986:

"The history of the founding and early years of the Lying-in Hospital is not, however, simply the tale of one exceptional man, no matter how public spirited, imaginative or energetic. It is a part also of the story of mid-eighteenth-century Dublin: of the capital's physical development, of its social life, of its inhabitants both wealthy and poor, and of the age's attitude to religion, charity and child-bearing. It is also part of the wider history of midwifery in eighteenth-century Europe, a period of revolutionary change in that profession. Like most great people whose achievements match their vision, Bartholomew Mosse was not a man ahead of his time but one very much of it."

Mosse had the vision to want to create a whole complex, and he achieved it. This theatre itself was built to raise funds for the hospital, as was what is now the Ambassador Cinema next door. And that idea of buildings working for the purposes of the hospital has been regenerated recently with the restoration of the magnificent Pillar Room in which we will be dining later this evening. Indeed, I believe that Bartholomew Mosse would nod approvingly at the supportive role played by the Friends of the Rotunda Hospital in modern times.

And while still focusing on the physical aspects, I should mention the Hospital's architect, Cassells, not just for the aesthetic value of the building but also because the original buildings have proved to be enduringly functional. At the heart of Mosse's Hospital was the Chapel. This stands as a small oasis of beauty in the centre of one of Dublin's busiest areas. The quality of the exquisite plaster work, executed I believe by an Italian stuccist Cramillion, never fails to make an impact on the first time visitor to the Chapel. To this day, the Chapel is an important part of the Hospital, providing a frequent and important meeting ground between different denominations. I know that the Hospital actively encourages inter-denominational worship and it is therefore appropriate that the 250th anniversary celebrations started with a service presided over by Dublin Archbishops, Dr. Caird and Dr. Connell.

At the time of its founding, one hundred years before the great famine and twenty years following a less well documented but also grave famine, the poverty in parts of the city of Dublin was unimaginable by today's standards. At that time childbirth was extremely dangerous. One in fifty mothers delivering would have died and many more would have been left with physical scars of long and unattended labours. And what of the emotional scars?

Professor Cormac O'Grada conveys the background well in his contribution to the 250th anniversary edition, where he draws on the work of James Whitelaw, who surveyed the city meticulously in 1798. Let me borrow a few lines from each to set the scene: Whitelaw describes the acute overcrowding:

"A single apartment, in one of these truly wretched habitations, rates from one to two shillings per week; and, to lighten this rent, two, three and even four families, become joint tenants. As I was usually out at very early hours on the survey, I have frequently surprised from ten to sixteen persons, of all ages and sexes, in a room, not fifteen feet square, stretched on a wad of filthy straw, swarming with vermin, and without any covering, save the wretched rags that constituted their wearing apparel . . ."

and O'Grada himself adds:

"Most of the Rotunda's patients continued to live in such unhealthy conditions for many more decades. They were probably less well fed than country people, and in the eighteenth and nineteenth centuries they lived short and harsh lives."

Set against that stark background, I am pleased to note the very early stage at which a connection was established between the Rotunda Hospital and the office holder in what is now Aras an Uachtarain. As President of Ireland I was conscious that in taking on the position as President of the Rotunda Hospital I followed in the footsteps of my six predecessors in office. They, in turn, carried on a tradition which goes back to the granting of the original charter of the Rotunda Hospital by King George II on 2 December 1756. That charter provided for a President, and the Lord Lieutenant of the day, the Duke of Dorset, was to become the first President. His successor as Lord Lieutenant, and as President of the Hospital, the Duke of Bedford, opened the present building officially on 8 December 1757. Every Lord Lieutenant in succession, and subsequently the Governors General under the Irish Free State Constitution, filled the position which is now held by me as President of Ireland. Although the position is an honorary one, it was valued by my predecessors. For example, President Sean T. O'Ceallaigh opened the International Congress held to celebrate the bi-centenary of the foundation of the Rotunda in 1947, and my distinguished predecessor, Dr. Patrick Hillery, attended a number of functions in the hospital, notably celebrations of the Royal College of Surgeons of Ireland.

In my honorary capacity as President I would like to pay tribute to the Hospital Governors, with whom responsibility for running the Hospital lies. The Governors are drawn from a diverse range of backgrounds and give generously of their time and expertise on a voluntary basis. Tribute should also be paid to the Master who is elected by the Governors and responsible for the day to day running of the Hospital. While it may have been possible for one individual to have performed this role 250 years ago, the complexity of the task has grown with advances in specialisation and the overall development of the service. Where in the past the Master would have been personally and immediately responsible for all aspects of patient care, the modern day role of the Master is to create the correct working environment in which medical and midwifery colleges can best bring their talents to bear on the patients in their care. The burden of responsibility to ensure that childbirth is as safe as possible is a major one. It is one that is carried comfortably by Dr. Mc Kenna, his Assistant Masters and the medical and midwifery staff of the Hospital.

I feel I have a special advantage over my many and illustrious predecessors who served as President of the Rotunda. I am the first to be a mother. This may also explain in part why I was invited to become Patron of both the National Maternity Hospital in Holles Street and the Coombe Women's Hospital, and why I accepted willingly. I am glad to have had opportunities to visit all three hospitals, and to witness first hand the dedication of the staff and the standard of care in each.

The single most important element of each hospital's work remains the care in pregnancy of patients and the safe delivery of their babies. To the pregnant women who have come to the Rotunda the importance of this work has not diminished one iota over two hundred and fifty years. The only difference is that society at large now acknowledges the importance of suitable care for the mother and her child. And in preparing this memorial lecture I thought it would be appropriate to have some substantive content, for which I would draw upon my own personal experience as a mother, and on the opportunities I have had as President to observe directly and to listen to a wide range of views and experiences on the subjects concerned. I would like to address two issues, chosen because they are essentially about attitudes, and so it may be helpful to highlight them in this way.

The first issue is the level of breastfeeding by mothers in Ireland. Why is the percentage level as low as it is?

I am aware of considerable improvement over the years, but I have an indelible memory which prompted my own early and sustained interest in this subject. My three children were born in Holles Street, the first in October 1972. I still recall vividly day two, and my sense of satisfaction at having established a reasonable pattern in breastfeeding my beautiful baby daughter. The door opened and a cheerful young nurse came in with what looked like a test tube. She asked if I would express some breast milk into it for her. I declined on the basis of shepherding scarce resources and her face fell. "You see", she said, "you are the only mother actually breastfeeding in the hospital just at the moment, and we are carrying out a series of tests . . .", and so I shared my milk! When I returned in 1974 I was no longer an isolated breastfeeding mother, and by 1981 - if I recall correctly - there were about 15% of mothers breastfeeding.

I read with interest the 1994 report to the Minister for Health by the National Committee to promote breastfeeding, entitled "a national breastfeeding policy for Ireland". The report refers to Ireland's relatively low level of breastfeeding as follows:

"There is evidence that Ireland compares unfavourably with many other countries both in terms of initiation and duration of breast feeding. In 1990 (the latest year for which national statistics are available) 31.7% of Irish mothers were breastfeeding at discharge from hospital. As already mentioned the incidence of breastfeeding is particularly low in the lowest socio-economic groups. A more recent study undertaken in 1992 in an urban community showed that this difference in uptake between socio-economic groups still persists. The most recent national figures for duration of breastfeeding refer to 1986 when only 15% of mothers were breastfeeding at 3 months. Anecdotal feedback from health professionals suggests that this percentage has decreased since then."

As President I have, of course, no role in policy, but I would like to understand the why of it, and what would influence the attitude of mothers themselves. Is part of the answer to have more seminars like the one I opened last January in the Coombe Women's Hospital entitled "Becoming a Mother"? I was impressed by the broad participation, which included hospital staff, women who were users of maternity services, women taking part in personal development courses organised by Cross Care, and the use of a community drama group to act out some of the relationships in hospitals. It seemed to me to be a very open, listening approach, a respectful dialogue, and an environment which could encourage mothers to appreciate their role in knowing what was best for them as mothers, and for their babies, and in helping to shape maternity services accordingly.

The other issue I wanted to touch on is the way our maternity and children's hospitals cope with grieving for the death of a baby or young child. Do we know enough about grieving, and about expressing grief? The Child Bereavement Trust in Britain has brought out a valuable book "Grieving After the Death of your Baby" which emphasises that parents and families have to find their own ways of grieving:

"Grieving is never easy, but grieving for a baby can be especially hard. The death of a baby is so shocking. It's a death that should never happen. There seems no reason why a baby should die, and for many parents, no reason is discovered for their baby's death. As a result, parents often blame themselves. They feel they have failed their baby and failed as parents. They feel angry with themselves, with doctors and nurses, with God. They feel bitter, because others have children and they have not. Above all, they feel desolation and despair because the baby they wanted has died, because their future together has been denied them, and because their love for their child now has no course to run."

Is it fully appreciated how vulnerable parents are in those early days of grieving - that the wrong word so increases the hurt and is never forgotten? I pose the question because in listening to individual members of I.S.A.N.D.S., the Irish Stillborn and Neo-natal Death Society, and in looking at the quilts which have helped to express a parent's grief, I have been struck by the amount of additional pain suffered. Last May I got a letter from one such mother:

"Dear President Robinson,

I have just come in after being at a Memorial Service in Glasnevin to mark the life and death of so many little babies. It is so easy to see the sadness even in the older parents that lost so very long ago. I myself had a beautiful little baby girl eighteen months ago. She was born with spina bifida and hydrocephalus and we were told at her birth she would live just hours. We brought her home some days later and we nursed and loved her for six sad but very precious weeks. As difficult as it was I would do it all again for just another day with her. The storm of emotions that followed Ruth's death seemed at times to be abnormal. Grieving for a baby is a lonely experience, there's a general lack of understanding of just how huge an impact a little lifetime can have on parents and other family members. Every word spoken whether good or unintentionally hurtful, the simplest of human gestures, are forever engraved. We don't expect everyone to know the right thing to say and so many sadly get it wrong, but there are some in important roles that should. In most cases they are wonderful but there are still a few who need to listen. These people are so important - the doctors, nurses, midwives, chaplains; sometimes they are the only evidence that yes, there was a heartbeat, he did take a breath, she did open her eyes and what they say is part of what we remember for all time. . . In my own experience something hurtful that was said by a doctor will tarnish my own precious memories forever. We shouldn't have to cope with anything more than the loss itself."

The eloquence of the writer struck a chord in me, and reminded me of a poem by our Nobel Laureate. In "Elegy for a Still-Born Child" Seamus Heaney revealed with great insight the pain of a mother and the pain of a father:

"Your mother walks light as an empty creel

Unlearning the intimate nudge and pull

 

Your trussed-up weight of seed-flesh and bone-curd

Had insisted on. That evicted world

 

Contracts round its history, its scar.

Doomsday struck when your collapsed sphere

 

Extinguished itself in our atmosphere,

Your mother heavy with the lightness in her.

 

For six months you stayed cartographer

Charting my friend from husband towards father.

 

He guessed a globe behind your steady mound.

Then the pole fell, shooting star, into the ground."

 

But as well as learning of the pain that can be caused, I have also had opportunities to see some of the thoughtful ways in which the need for grieving is being understood and supported. I recall visiting the National Children's Hospital in Harcourt Street last year to open the new mortuary - bereavement facilities there. I admired the waiting room, the bereavement room and the mortuary area, but most of all I was impressed by the involvement of transition year students from Ballyfermot Vocational School in the woodwork, the altar and the stained glass windows, all of which were provided and funded by the school itself. More important than the physical work done by the students was their emotional involvement. These young people were being prepared for one aspect of parenthood which I hope they will never encounter.

Another welcome development has been the emerging consciousness of the importance of finding the language to help rather than hurt. And I would like to broaden out that significance of language - of finding the right words - from the intensity of coping with grief to all the relationships and all the experiences in our maternity hospitals. It was an imaginative step by Holles Street Hospital during its own centenary year to invite Eavan Boland to become poet in residence there, and to issue a special edition of her poems in "Night Feed".

And let us remember, on this special commemorative occasion, the cultural contribution of the Rotunda Hospital from its very establishment. In February 1746, less than a year after it had opened, Mosse initiated what Brian Boydell described as the "most successful, consistent and long lasting" concerts, it was the place of assemblies and balls, of dining and theatre. It was the true forerunner of our modern sense of the maternity hospital as a community which is enriched by the gifts and interpretations of artists who are able to honour both individual and community through their work.

What has changed - and for the better - is that the modern maternity hospital has established a new dialogue with its patients, and therefore a new and challenging dialogue with the society of which they are a part. The story of this hospital has been central to the lives of women, of mothers, for 250 years. Now our idea of community, including the community that is a hospital, has changed and has been subtly revised by a new exchange between ideas of the individual and fresh thinking about society in general. In the making of this revision, the creativity of women has played a major part. For that reason, I would like to conclude by quoting a poem which is a profound celebration of what it is to be a woman, and, indeed, to age as a woman. The poem is Anna Liffey by Eavan Boland, and these are the concluding lines:

In the end

It will not matter

That I was a woman. I am sure of it.

The body is a source. Nothing more.

There is a time for it. There is a certainty

About the way it seeks its own dissolution.

Consider rivers.

They are always en route to

Their own nothingness. From the first moment

They are going home. And so

When language cannot do it for us,

Cannot make us know love will not diminish us,

There are these phrases

Of the ocean

To console us.

Particular and unafraid of their completion.

In the end

Everything that burdened and distinguished me

Will be lost in this:

I was a voice.